POS0625 VASCULAR EFFECT OF INFLAMMATORY BURDEN IN EARLY RHEUMATOID ARTHRITIS PATIENTS - A 5-YEAR PROSPECTIVE STUDY
Authors: H. Meng, I. T. Cheng, B. P. Yan, A. P. W. Lee, H. So, L. S. Tam
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are associated with accelerated atherosclerosis driven by chronic Inflammation. We have previously reported that cumulative inflammatory burden, as reflected by cumulative averages of repeated measures of erythrocyte sedimentation rate (ca-ESR), was associated with increased arterial stiffness in PsA patients (1). Objectives To ascertain whether inflammatory burden over time is associated with long-term vascular outcome in early RA (ERA) patients. Methods In this 5-year prospective study, consecutive ERA patients without overt cardiovascular disease were recruited. All patients received tight-control treatment in the first year followed by stand-of-care management subsequently. Subclinical atherosclerosis and arterial stiffness progression were assessed using high-resolution carotid ultrasound (US) and brachial-ankle pulse wave velocity (PWV) respectively at baseline, year 1 and year 5. The primary outcome was subclinical atherosclerosis progression (AP+), defined as incident plaque in a segment without plaque before, or an increased number of plaques in a segment, and/or maximum carotid intima-media thickness (max cIMT) over 0.9 mm at year 5. Secondary outcome was the change in PWV over a period of 5 years. ESR level was measured during each clinic visit. Inflammatory burden was measured by cumulative averages of the area under the curve for erythrocyte sedimentation rate (ESR) over a period of 5 years. Results One-hundred and four ERA patients (age: 52±11 years, 81(78%) female) who completed 5 years of follow-up were included in this analysis. Significant improvement in disease activity was observed (DAS-ESR at baseline: 5.8±0.9 vs 3.2±1.2 at year 5, p &lt;0.001). Forty-two patients (40.4%) had AP+. The AP+ group had higher ca-ESR (37.6±16.4 vs 32.0±17.1, p =0.106) and baseline Framingham risk score (FRS) (13.3±12.5 vs 5.5±6.6, p &lt;0.001). Multivariate logistic regression analysis revealed that a higher ca-ESR was associated with AP+ (OR=1.03, 95%CI: 1.00-1.06, p =0.038) after adjustment for baseline high risk Framingham risk score (FRS≥20%) and baseline triglycerides level (Table 1). Similarly, PWV increased from 1461±285cm/s to 1559±309cm/s ( p &lt;0.001) after 5 years. Higher ca-ESR correlated with PWV progression (r=-0.211, p =0.032). Using multivariate logistic regression analysis, ca-ESR was associated with arterial stiffness progression ((β=2.94, 95%CI: 0.80 to 5.08, p =0.007) after adjusting for symptom duration, presence of rheumatoid factor and FRS. Table 1. Univariable analysis on baseline clinical characters and progression of subclinical atherosclerosis parameters AP+ ba PWV change Univariate model Multivariate model Univariate model Multivariate model OR p Value OR p Value β p Value β p Value 95% CI 95% CI 95% CI 95% CI Symptom duration 0.99 0.704 5.62 0.089* 0.92-1.06 -0.88-12.131 RF positive 0.99 0.692 84.04 0.068* 84.25 0.049 0.92-1.06 -6.48-174.55 0.38-168.12 Baseline Triglycerides 3.19 0.009* 3.48 0.008* -39.05 0.266 1.34-7.61 1.38-8.76 -108.25-30.14 FRS, 20% 5.97 0.031* 5.65 0.500 -164.11 0.013* -149.48 0.017* 1.17-30.39 1.00-31.80 -292.67- -35.55 -1.25-10.87 ca-ESR 1.02 0.106 1.03 0.038* 3.12 0.005* 2.78 0.008* 1.00-1.04 1.00-1.06 0.97-5.27 0.73-4.82 *Statistically significant at p &lt; 0.05. RF positive: Rheumatoid factor positive, FRS, 20%: Framingham risk score ≥20%, caESR: cumulative average-Erythrocyte sedimentation rate. Conclusion Persistent inflammation was an independent predictor of subclinical atherosclerosis and arterial stiffness progression in ERA. Effective long-term suppression of inflammation is required to minimize cardiovascular risk. References [1]Shen J, Shang Q, Li EK, Leung Y-Y, Kun EW, Kwok L-W, et al. Cumulative inflammatory burden is independently associated with increased arterial stiffness in patients with psoriatic arthritis: a prospective study. Arthritis research &amp; therapy. 2015;17(1):75. Acknowledgements I have no acknowledgments to declare. Disclosure of Interests None declared